Understanding help-seeking in older people with urinary incontinence

Introduction: Continence services can be based in hospital or community settings and provide a general or specialised service and support for patients. We explored the views of older people with urinary incontinence (UI) on the process of seeking help in three different settings.Methods: Older people with UI were recruited via purposive sampling from three continence services in the north of England including: a geriatrician-led hospital outpatient clinic (n = 18), a community-based nursed-led service (n = 22) and a consultant gynaecologist-led service specialising in the surgical treatment (n = 10). Data generated via semi-structured interviews were analysed using framework analysis.Results: Patients delayed seeking help for their UI due to a number of reasons. Recurring themes included: embarrassment; tolerating UI by developing coping mechanisms; perceiving UI as a normal part of the ageing process and patients' ignorance that help was available.The majority of patients sought help only when their UI had significantly impacted on their quality-of-life. Identified themes for help seeking included: experience of being unable to control the bladder in public; being prompted by a loved one; or if patients perceived the cause to be life threatening.When patients did seek help some found that general practitioners did not prioritise or recognise their concerns and did not respond with treatment. In contrast a number of patients identified that their incontinence had been picked up during a comprehensive assessment by a geriatrician.Conclusions: This study provides a valuable insight into help-seeking in older people with UI. Comprehensive geriatric assessment appears an important trigger for referral and treatment in our participants, some of whom had already experienced a reduced quality-of-life due to UI.